Talking Openly About MOUD in Recovery Fellowships. A Guide for Clinicians, Patients and Loved Ones

“Shattering the STIGMA [1]” explores the ongoing tension between evidence-based addiction treatment and long-standing cultural beliefs in some AA and NA communities. Despite decades of research showing that Medications for Opioid Use Disorder (MOUD) such as buprenorphine, methadone, and naltrexone reduce relapse, overdose risk, and mortality, certain recovery circles still view these medications as incompatible with “real sobriety.” This stigma, which is reinforced by language, literature, and sponsor influence, forces individuals to choose between life-saving treatment and social belonging. We summarize our original work here as an approachable guide for clinicians, patients, and loved ones.

Despite strong scientific evidence supporting MOUD, stigma persists in some AA/NA circles where these medications are seen as incompatible with sobriety or “unclean.”

The article traces stigma back to early AA writings, which expressed caution toward psychiatric medications, largely due to concerns around impairment rather than addiction treatment. NA’s persistent use of the word “clean” further reinforced the idea that using MOUD means one is not truly in recovery. While antidepressants are gaining acceptance in recovery communities, MOUD remains stigmatized, particularly due to misunderstandings around “dependency” versus “addiction.”

We illustrate the emotional and clinical consequences of this stigma through the real case of a 33-year-old man. The subject began buprenorphine treatment but insisted on discontinuing it before discharge because his sponsor told him it made him “unclean.” While he improved clinically, experiencing reduced cravings and increased hope, he felt pressure to abandon treatment to remain accepted by his fellowship group. This forced choice put his recovery and life at risk.

MOUD acts as a gateway to recovery. These medications stabilize neurobiology, reduce craving, and create the psychological and physiological space needed for therapy, spiritual development, and personal growth. They support the recovery process by enabling people to meaningfully engage in the therapeutic alliance and community healing.

True recovery isn’t simply the absence of substances. It’s also the presence of healing, accountability, honesty, connection, and purpose. Fellowship principles like humility, compassion, and service align naturally with the acceptance of MOUD as an essential support for some individuals. No one should have to choose between medication and belonging. 

Action items 

For Clinicians:

• Introduce MOUD discussions using nonjudgmental, recovery-aligned language
• Normalize MOUD as part of a holistic treatment plan, not a separate option
• Share real success stories from individuals thriving in both fellowships and medication-supported recovery
• Support patients in navigating recovery spaces while affirming their medical needs 

For Fellowship Members, Sponsors, & Peers:

• Shift language from “clean” vs. “on meds” to terms like “engaged in recovery,” or “stabilized”
• Provide sponsor coaching and interactions to help peers support individuals on MOUD without judgment
• Promote fellowship equality—no “medication” shame, no second-class recovery
• Welcome members who are using evidence-based treatment 

For Treatment Centers & Addiction Medicine Programs:

• Integrate MOUD education into family therapy, discharge planning, and aftercare coordination
• Prepare patients with tools to advocate for their recovery needs in community settings
• Develop alumni groups or 12-step alternative spaces where medication-supported recovery is embraced 

Key message 

MOUD and recovery community involvement should be allies. With education, language change, and compassionate practice, we can eliminate stigma, protect recovery, and make belonging possible for all.

1. Klein S, Franco J, Scioli A (2026) Shattering the STIGMA: Talking openly about MOUD in 12-step recovery programs. J Subst Use Addict Treat 181: 209829.